A recent California Supreme Court decision Kirk King et al., v. Comppartners, Inc., et al. recently held that utilization review physicians do not owe a duty of care to injured workers. In King, the applicant was being prescribed Klonopin for a 2008 back injury that led to chronic pain and depression. The Klonopin was prescribed by King’s treating physician and the medication had worked well for him and he had been using it for two years.
A request for the Klonopin was sent to Utilization review, and Dr. Naresh Sharma, determined that the medication was not medically necessary. Dr. Naresh Sharma did not perform and interview or examination on King. Due to the fact the Klonopin was denied to applicant, the withdrawal of the medication caused King to suffer from four seizures.
It was asserted by King that Sharma and his utilization review employer acted with negligence, and further argued that the employer and the physician should be disciplined and sued.
Although the court found that Sharma did not owe a duty of care, they did make a significant note that the utilization review process may not be in proper working order. One of the justices commented that because the protections of injured workers may not be working at optimal levels that the Legislature may find that it would make sense to alter them.
Changes to the utilization review process may be seen as soon at 2019. This may include that utilization review doctors may be held to a higher standard such as the same duty of care as that of treating doctors. Another change could be the requirement of utilization doctors to be licensed in the state wherein they provide their utilization review opinions. This also includes that they would be subject that state’s medical board for disciplinary actions. There may be certain changes in regards to the procedure of how the utilization review process such as the interview and examination of the applicant. Further, there may be an increase in the applicant’s disability payments should a harmful or wrongful determination be issued against them.